Cancer surgery canceled over prior auth

Dr. Elisabeth Potter’s original social-video account dates to January 2025 and described an operating-room interruption during a breast-reconstruction procedure by a UnitedHealthcare call. cnn.com UnitedHealthcare publicly disputed Potter’s account and the company pursued legal threats, while reporting in August 2025 said Potter claimed roughly $5 million in debt and risk of bankruptcy tied to the dispute. nurse.org At a June 23, 2025 HHS/CMS roundtable, HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz secured voluntary commitments from major insurers—including UnitedHealthcare, Aetna, Elevance, Humana, Cigna and Centene—to adopt six reforms such as FHIR-based ePA standardization and reducing the volume of services requiring prior authorization by January 1, 2026. cms.gov CMS had already finalized the CMS-0057-F interoperability and prior-authorization rule on January 17, 2024, which set implementation deadlines effective January 1, 2026 and called for payer reporting of PA metrics (initial sets due March 31, 2026). cms.gov Independent checks show patchy follow-through: KFF Health News reported that when it contacted more than a dozen insurers in February 2026, about half could not specify which services they would remove from prior-authorization requirements after the June pledge. kffhealthnews.org Operational scale underlines the problem: KFF’s February 2026 analysis found Medicare Advantage plans processed 52.8 million prior-authorization requests in 2024, with 4.1 million full or partial denials and 80.7% of those denials overturned on appeal. asge.org CMS’s June 2025 pledge also sets a timetable for technically enabled wins—real-time approvals for most requests by 2027 and continued CMS monitoring of insurer progress—while providers on the front lines, like Potter, report that day-to-day claims workflows and departmental data silos still produce care-stopping breakdowns. cms.gov